Emergency medicine stands out as one of the UK’s most structurally dependent specialties on doctors working outside the specialist register, according to new GMC analysis in the Workforce report 2025.  

Using England and Wales NHS contracts data, the report compares the number of locally employed (LE) and SAS doctors working in different specialty areas against the number of doctors on the specialist register with a qualification in that specialty. The result is expressed as a ratio: LE-to-specialist and SAS-to-specialist.  

In 2024, emergency medicine recorded: 

• 1.4 LE doctors per specialist (with an emergency medicine specialty qualification) 

• 0.57 SAS doctors per specialist—the highest SAS ratio among specialties  

The report contrasts this with specialties such as radiology and pathology, which had the lowest reliance on LE doctors: 

• Radiology and pathology: 0.06 LE doctors per specialist 

• SAS ratios: 0.04 (radiology) and 0.07 (pathology)  

The report notes that while ratios increased across most specialties between 2020 and 2024 (except occupational health), some of the most notable increases were observed in psychiatry and obstetrics and gynaecology, indicating broader reliance on LE roles beyond emergency medicine.  

Why it matters: Emergency medicine is already widely viewed as a highpressure environment, and the workforce mix described by the GMC suggests that service provision depends not only on specialists and trainees but also on a significant cohort of doctors in LE and SAS roles. That matters for staffing resilience, supervision capacity and continuity, particularly if LE employment conditions are insecure. The report shows LE doctors are far less likely to have permanent contracts than SAS doctors (only 9% of LE doctors with permanent contracts in England and Wales in 2024, compared with 83% for SAS).  

The report also links emergency medicine to international workforce dependency. In Part 1, it explicitly notes that emergency medicine has the highest proportion of nonUK PMQ doctors, not only among specialists but also in SAS and LE roles working alongside them.  

What to watch: The report’s broader narrative about a potentially tightening job market for newly arrived international doctors, and policy debates about training prioritisation, could have spillover effects for specialties like emergency medicine that rely on internationally qualified doctors in nontraining service roles. Workforce planning for emergency medicine, the data suggests, may need to focus as much on stabilising LE and SAS roles as on specialist headcount alone.